根治性全胃切除术后uncut Roux-en-Y吻合的应用研究

Application value of uncut Roux-en-Y anastomosis after radical total gastrectomy

摘要:

摘要：目的  探讨uncut Roux-en-Y吻合技术在根治性全胃切除术后消化道重建中的安全性和疗效。方法  回顾性分析163例因胃癌行根治性全胃切除患者的临床资料。根据不同的消化道重建方法分为uncut组和Roux组，比较两组患者的消化道重建时间、术后近远期并发症情况、术后12个月的单餐进食量、预后营养指数（PNI）、Visick分级指数。结果  ①两组消化道重建时间比较，差异有统计学意义（P <0.05），uncut组短于Roux组；②两组术后近期吻合口并发症、术后倾倒综合症、反流性食管炎发病情况比较，差异无统计学意义（P >0.05）；③Roux滞留综合症（RSS）发病情况比较，差异有统计学意义（P <0.05），uncut组较Roux组降低；④两组PNI变化趋势不同，术后12个月PNI比较差异有统计学意义（P <0.05），术后12个月uncut组PNI高于Roux组。术后12个月VisickⅠ、Ⅱ级患者比例及单餐进食量达术前80%的患者比例，差异有统计学意义（P <0.05），uncut组优于Roux组。结论  uncut吻合不增加手术风险、操作难度及术后吻合口并发症，但在改善患者进食、营养状况，减少RSS并发症方面具有优势，具有临床推广价值。

Abstract:

Abstract: Objective To analyze the safety and effect of uncut Roux-en-Y esophago-jejunostomy in the digestive tract reconstruction after radical total gastrectomy. Methods The clinic data of 163 cases who underwent radical total gastrectomy for gastric cancer were retrospectively analyzed. They were divided into uncut Roux-en-Y group (uncut group) and pure Roux-en-Y group (Roux group) according to the ways of digestive tract reconstruction. Surgical reconstruction time, incidences of early and long-term postoperative complications, occurrence of Roux stasis syndrome (RSS), single meal intake 12 months after operation, the prognostic nutritional index (PNI) and the Visick rating index were compared. Results The time of digestive tract reconstruction in the uncut group was significantly shorter than that in the Roux group (P < 0.05). There was no significant difference in the incidence of the early postoperative anastomosis complications, postoperative dumping syndrome or reflux esophagitis between the two groups (P > 0.05). The incidence of RSS in the uncut group was significantly lower than that in the Roux group (P < 0.05). The variation trends of the PNI were different in the two groups, the PNI in the uncut group was significantly higher than that in the Roux group 12 months after operation (P < 0.05). The proportions of the patients of the Visick grade Ⅰ and Ⅱ and the food intake reaching 80% of the preoperative level in the uncut group were significantly higher than those in the Roux group 12 months after operation (P < 0.05). Conclusions The uncut Roux-en-Y anastomosis doesn't increase the operative risks or the occurrence rates of the postoperative anastomosis complications, while has apparent advantages in the improvement of postoperative food intake and nutrition status and reduction of occurrence rate of RSS; therefore it has the value of clinical promotion.